From the Guidelines
Atrial fibrillation with rapid ventricular response (AFib RVR) is defined as an irregular heart rhythm originating in the atria with a ventricular rate that can be exacerbated by worsened heart failure (HF), as stated in the 2014 AHA/ACC/HRS guideline 1. This condition occurs when the chaotic electrical signals from the atria overwhelm the atrioventricular node's ability to regulate impulses, resulting in a fast and irregular heartbeat. The main goals of therapy for those with AFib RVR and HF are prevention of thromboembolism and control of symptoms, with most patients being candidates for systemic anticoagulation unless contraindicated 1. Key aspects of management include:
- Correction of underlying causes of AFib RVR and HF
- Optimization of HF management
- Consideration of rate control versus rhythm control strategies
- Potential use of rate control medications, such as beta blockers, which are preferred due to their favorable effect on morbidity and mortality in patients with systolic HF 1 Some important points to consider in the management of AFib RVR include:
- The use of beta blockers, such as metoprolol, as the preferred agents for achieving rate control unless otherwise contraindicated 1
- The potential role of digoxin as an effective adjunct to a beta blocker 1
- The cautious use of nondihydropyridine calcium antagonists, such as diltiazem, in those with depressed EF due to their negative inotropic effect 1
From the Research
Definition of Afib RVR
Afib RVR, or atrial fibrillation with rapid ventricular response, is a common dysrhythmia associated with significant morbidity and mortality 2. It is characterized by a rapid heart rate, which can lead to complications such as hypoperfusion and cardiac ischemia 3.
Key Characteristics
Some key characteristics of Afib RVR include:
- Atrial fibrillation with a rapid ventricular rate/response (RVR) 3
- Heart rate greater than 100 beats per minute 4
- Potential for complications such as hypoperfusion and cardiac ischemia 3
- Importance of rate control to prevent adverse outcomes 2, 3
Management
Management of Afib RVR typically involves rate control using beta blockers or calcium channel blockers 3, 4, 5, 6. The choice of medication depends on individual patient factors, such as comorbidities and clinical situation 2. Some studies suggest that beta blockers may be more effective than calcium channel blockers for rapid reduction of heart rate 6, while others found no significant difference between the two 4, 5.
Treatment Options
Treatment options for Afib RVR include: